Medico

CHAPTER

4

The Doctor–Patient Relationship
Myfanwy Morgan

SOCIAL ROLES OF DOCTORS AND PATIENTS s Parsons’ model of the sick role and doctor’s role s Conflicts in the doctor’s role s Psychosocial and clinical outcomes TYPES OF DOCTOR–PATIENT RELATIONSHIP s Models of the doctor–patient relationship s Influences on the doctor–patient relationship PARTNERSHIPS IN TREATMENT DECISION-MAKING sModels of decision-making s Shared decision-making and treatment choices s Patients’ preferences for participation DOCTORS’ COMMUNICATION SKILLS s Content and process skills s Special situations and groups CHANGES IN THE DOCTOR–PATIENT RELATIONSHIP

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The essential unit of medical practice is the occasion when, in the intimacy of the consultingroom, or sick room, a person who is ill, or believes him- or herself to be ill, seeks the advice of a doctor whom he or she trusts. Such meetings are a frequent and regular occurrence, with over half a million consultations occurring between general practitioners and their patients in the UK every working day and a large number also taking place at a hospital level. Their success or otherwisedepends not only on the doctors’ clinical knowledge and technical skills, but also on the nature of the social relationship that exists between doctor and patient. This chapter first examines the general societal expectations that influence the behaviours of doctors and patients in the medical consultation. It then describes some of the conflicts that can be experienced by doctors and different formsand determinants of the relationship between doctors and patients. Finally, the chapter examines the new partnerships that are developing involving shared treatment decision-making between doctor and patient and considers technical aspects of communication including new sources of information and decision aids.

PART 2 SOCIAL FACTORS IN MEDICAL PRACTICE

SOCIAL ROLES OF DOCTORS AND PATIENTSParsons (1951) was one of the earliest sociologists to examine the relationship between doctors and patients. His interest arose from a broader theoretical concern with how society is able to function smoothly and respond to problems of deviance. Parsons regarded social functioning as partly achieved through the existence of institutionalized roles with socially prescribed patterns of behaviour.We are, therefore, all aware how people are likely to behave when they occupy the role of father, teacher, shop assistant, and so on, and of their expectations of us when we occupy the complementary role of child, pupil or customer. Parsons regarded illness as a form of social deviance because it impairs normal role performance and, if it occurs on a large enough scale, the smooth functioning ofsociety (e.g. families caring for children, educational system, transport system, etc.) will be put at risk. Parsons believed that the amount of illness is controlled through the socially prescribed roles for doctors and patients, which facilitate interaction, and ensure both parties work together to return people to a state of health and normal role performance as quickly as possible.

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sParsons’ model of the sick role and doctor’s role
Parsons’ description of the roles of doctor and patient is presented as an ‘ideal type’ model. This abstracts and presents what are regarded as the fundamental features of a particular social organization or social role and is an important method of analysing and describing very complex social phenomena. Parsons depicted the role of sick people asinvolving four general expectations. First, sick people are allowed, and might even be required, to give up some of their normal activities and responsibilities, such as going to work or playing football. Second, they are regarded as being in need of care. These two expectations and privileges are, however, contingent on the sick person fulfilling the third obligation of wanting to get well as...